What is rickets?
Despite this victorian disease being virtually wiped out due to improvements in diet and the fortification of milk and cereals, in recent years the numbers of children presenting with symptoms has increased across the UK.
This disease: a softening of the bones leading to deformaties, is usually seen in children suffering from malnutritian, famine and starvation. Somewhat worryingly it is reappearing in the UK.
What causes rickets?
The main cause of Rickets is a deficiency in Vitamin D. Calcium deficiency can also be a cause. Once you realise that our main sources of Vitamin D are oily fish, eggs and natural sunlight, you immediately start to see why a deficiency may be occurring.
Children are spending a lot of time indoors and when they do go out in the sun we are slathering on the suncream at the first inclining of a sunny day. Additionally, many children may be covering up for cultural and religious reasons.
The natural sunlight that is required to absorb enough Vitamin D isn't much; 10-15 minutes of sun exposure on hands and face a few times a week. However it's the UVB rays that induce the vitamin D into our skin, which can't get through if we are covered in sunscreen at all times. In the UK we use our winter stores of Vitamin D between November and April (when the UVB rays aren't strong enough); but need to get enough Vitamin D in the summer months.
Risk of rickets versus the risk of sun burn
And so here we reach the problem for mothers; how do you ensure your child is getting enough exposure to the sun to avoid a Vitamin D deficiency, whilst also ensuring they don't burn?
For children with fair skin, the NHS suggests allowing 10-15 minutes a day (no longer) of time in the sun without sunscreen. The more skin that is exposed the more Vitamin D will be stored and the shorter the time of exposure required. Obviously it is then important to apply sunscreen to avoid the risk of burning and many cancers.
In my case I know I can burn with just 10 minutes unprotected exposure at 1pm, but at 10.30am or 3pm I am usually safe to go without sunscreen for short periods. Use the knowledge you have of your own skin as a starting point.
And of course, if you and your child do not burn within 15 minutes in the UK sun, this may not be the case when you jet off to the Mediterranean for your holidays. The closer to the equator you get, the stronger the sun. The children will probably spend most of their Mediterranean holiday outside and in swimsuits, so it's probably safer to avoid any unprotected time for those two weeks unless it's perhaps later in the evening, when the sun is still out but is less strong.
Dark skin requires slightly longer to absorb the Vitamin D. Those of African Caribbean and South Asian descent are at greateer risk of Vitamin D deficiency. Start with small amounts of unprotected time in the sun at cooler times of the day, and build up gradually to approximately 10-15 minutes. Again, the more skin that is exposed, the more Vitamin D will be absorbed.
Improving a child's diet
The following foods are rich in Vitamin D:
- Oily fish
- Breakfast cereals (check the label)
The risk to adults
It's worth pointing out that although Rickets is a childhood disease; Vitamin D deficiency in adults causes osteomalacia, which causes bone pain and tenderness, so it's just as important for us adults to get some sun exposure each day.
Vitamin D during Pregnancy
The NHS also recommends that pregnant and breastfeeding woman take a Vitamin D supplement to ensure their and their babies needs are met. Pregant women and children who qualify can obtain free supplements through the Healthy Start scheme. Supplements should not exceed 25 micrograms a day. (40IU = 1mg)
Care in the sun
You can't make too much Vitamin D from excessive sun exposure, but you can very quickly burn, so be careful, don't forget to apply that sun screen and if in doubt, cover up.
A video giving advice on how to apply sunscreen is here:
Sources and further information:
NHS Choices: Rickets
NHS Choices: Preventing Rickets
Rickets cases reported in Cardiff by health workers. July 2011
Sunscreen causes Rickets: New wave of cases in England. Feb 2011
More cases of Rickets turn up in UK, lack of sunshine exposure to blame. Aug 2011